Minimally Invasive Sliding Hip Screw Insertion Technique

Khan, Asif Z.; Parker, Martyn J.

doi:10.5301/hip.2012.9236

Cited by 3 publications

(3 citation statements)

References 10 publications

(5 reference statements)

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“… 31 Nowadays, in order to preserve blood supply at the fracture site and promote healing, more and more orthopedists advocate minimally invasive surgery. 32 , 33 Intramedullary nail caters to this concept and becomes a good choice of treatment for subtrochanteric fractures.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures

Wang

Ma²,

Jia³

et al. 2016

Medicine

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Subtrochanteric fractures are common and result in significant morbidity and mortality. Various kinds of implants have been used to fix it. The aim of this study was to compare the biomechanical performance of PFN, DHS, DCS, and the PFLP in the treatment of subtrochanteric comminuted fractures.A total of 32 antiseptic human femurs from 16 donors were randomly allocated to 4 groups for fixation with PFN, DHS, DCS, and PFLP. A 2-cm cylindrical bone fragment was removed 1 cm below the lesser trochanter to simulate OTA/AO 32-C3.2 post instrumentation fracture. All specimens in single-leg stance situation were preloaded 5 times at 100 N in the axial direction to eliminate the time effect of relaxation and settling, followed by cyclic testing at a rate of 1 Hz with stepwise increasing load. Keeping the valley load at a constant level of 100 N during the entire cyclic test, the peak load, starting at 200 N, was increased by 100 N at 300-cycle steps until a maximum of 1500 cycles or until failure of the bone-implant construct occurred. Each specimen was kept unloaded under 100 N compression for 30 minutes between the 300-cycle steps.Femoral head displacement after 1500 cycles was 1.09 mm ± 0.13 for PFN, 1.78 mm ± 0.25 for DHS, 2.63 mm ± 0.46 for DCS, and 2.26 mm ± 0.16 for PFLP, with significant difference between any 2 implants (P < 0.01). The required load to reach 1-mm femoral head displacement was 563.04 N ± 158.34 for PFN, 485.73 N ± 147.27 for DHS, 258.44 N ± 97.23 for DCS, and 332.68 N ± 100.34 for PFLP. Significant differences were detected between any 2 implants (P < 0.001), except between DCS and PFLP and between DHS and PFN. The number of cycles until 1-mm femoral head displacement was 1458 ± 277 for PFN, 908 ± 184 for DHS, 369 ± 116 for DCS, and 603 ± 162 for PFLP. Significant differences were detected between any 2 implants (P < 0.01), except between DCS and PFLP.From biomechanical point of view, comminuted subtrochanteric fractures OTA/AO 32-C3.2 revealed in the current test setup highest fixation strength with PFN, followed by DHS, PFLP, and DCS.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures

Wang

Ma²,

Jia³

et al. 2016

Medicine

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“…Metoda ošetření zlomenin proximálního femuru skluzným šroubem (DHS) je známá již téměř 60 let (26). V současné době je indikována zejména k ošetření stabilních pertrochanterických zlomenin, které se vyskytují nejčastěji u seniorů v osteoporotickém terénu (18,19,21). Výsledkům a komplikacím takto ošetřených zlomenin je věnována celá řada publikací v domácí i zahraniční literatuře (2,4,14,15,27).…”

Section: úVodunclassified

Dynamic Hip Screw Osteosynthesis for Proximal Femoral Fractures in Patients with Coxarthrosis

Hrubina¹,

Skoták²,

J³

2015

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYEvaluation of a group of patients with coxarthrosis who sustained fractures of the proximal femur and were treated by dynamic hip screw (DHS) osteosynthesis. MATERIAL AND METHODSThe group comprised 23 DHS osteosyntheses in 22 patients treated between the years 1997 and 2012.The indication to osteosynthesis in all 23 cases was a stable pertrochanteric fracture of the femur; all patients had grade III or grade IV coxarthrosis (assessed on the Kellgren & Lawrence scale) and their physical health was classified as ASA 3 or 4. Preventive antibiotic therapy was administered within 48 hours of surgery. The evaluated factors included operative time, blood loss, specific complications such as infection, osteosynthetic material fractiure or osteosynthesis failure, requirement of revision surgery, post-operative mobility and patient survival. The follow-up was 2 years. RESULTSThe operative time was 35 min to 85 min (average, 49 min); blood losses ranged from 50 ml to 450 ml (average, 189 ml). Of the 23 hips, infectious complication was found in one (4.3%) and osteosynthetic material fractiure also in one (4.3%). There was no necessity of revision surgery due to osteosynthesis failure, nor any conversion to total hip arthroplasty. Postoperative mobility (with use of walking aids or forearm crutches) was achieved in 17 (77.3%) patients. The average survival of the patients was 6.3 months, the range from 7 days to 3 years. DISCUSSIONDHS osteosynthesis is a reliable method for the treatment of proximal femoral fractures due to osteoporosis. These fractures in patients with coxarthosis are primarily indicated to total hip arthroplasty. However, this is questionable in polymorbid elderly patients in whom hip replacement carries high risk. In such patients DHS osteosynthesis is preferred as a less risky procedure. CONCLUSIONSDHS osteosynthesis is indicated for stable pertrochanteric fractures of the femur in a limited number of patients with advanced coxarthrosis in whom total hip replacement would be associated with an undue risk. The majority of patients after surgery became mobile, but with short-term survival.

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“…Khan a kol. udávají 1,7 % povrchových infekcí z 579 pacientů při použití miniinva-zivního přístupu u osteosyntézy, kdy vyšší výskyt může souviset se zhmoždením okrajů rány (14). Chirodian a kol.…”

Section: Diskuseunclassified

DHS Osteosynthesis for Proximal Femoral Fractures: Infectious Complications

Hrubina¹,

Skoták²,

J³

2013

Acta Chir. orthop. Traum. Cech.

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PURPOSE OF THE STUDYEvaluation of infectious complications in patients with proximal femoral fractures treated by osteosynthesis using dynamic hip screws (DHS). MATERIALThe group included 501 patients with 532 DHS procedures performed in the years 1996-2010. In 31 patients osteosynthesis was carried out bilaterally. METHODSOsteosynthesis was indicated for femoral neck fracture in 18 hips and for pertrochanteric fracture in 514 hips. Prophylactic antibiotic therapy was administered within 48 hours of surgery. The occurrence of infectious complications (surface and deep wound infection), presence of infectious agents, risk factors, and the course of treatment and its outcome were investigated. RESULTSOf 532 fractures treated by DHS osteosynthesis, seven were infected (1.3%) as follows: one fracture of the femoral neck with methicillin-resistant Staphylococcus aureus, and, of six pertrochanteric fractures, four with Staphylococcus aureus, one with Escherichia coli and one with Staphylococcus epidermidis. Surface wound infection was diagnosed in one case (0.2%) and deep infection in six cases (1.1%). Five revision DHS procedures were carried out in five patients. One or more risk factors were found in each patient with infected DHS. The treatment of infection included wound dressing and abscess drainage without reoperation in two cases, implant removal in three, and implant removal with femoral head resection and spacer insertion in two cases. Second-stage total hip arthroplasty (THA) was performed in one case. Of the seven infected fractures, five (71%) healed successfully. DISCUSSIOnDHS osteosynthesis is a reliable method for treating proximal femoral fractures. The 1.3% infection rate in our group is comparable with other relevant studies. This complication is serious and requires prolonged treatment but is not as devastating as an infected THA. For the treatment of infected DHS osteosynthesis, standard methods from screw removal to second-stage THA were employed. COnCLUSIOnSInfectious complications following osteosynthesis with dynamic hip screws are rare events in the treatment of proximal femoral fractures. Staphylococcus aureus was the most frequently isolated infectious agent. Each infectious complacation was associated with one or more risk factors. Antibiotic prophylaxis is important particularly in patients at risk.

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Minimally Invasive Sliding Hip Screw Insertion Technique

Cited by 3 publications

References 10 publications

Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures

Biomechanical Evaluation of Four Methods for Internal Fixation of Comminuted Subtrochanteric Fractures

Dynamic Hip Screw Osteosynthesis for Proximal Femoral Fractures in Patients with Coxarthrosis

DHS Osteosynthesis for Proximal Femoral Fractures: Infectious Complications

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